Faculty Bibliography

An aneurysm, a potentially fatal and common condition, is a ballooning of an artery, and it usually develops painlessly. The chief danger is that an aneurysm can burst suddenly, without warning, and cause death within minutes. The aorta, the body's main artery, carries blood from the heart to supply oxygen and other nutrients to the rest of the body. Until recently, the standard procedure for repairing an aortic aneurysm before it bursts involved making a long incision in the chest or abdomen, removing the damaged part of the artery, and replacing it with a prosthetic graft. The new procedure is less painful and seems to have fewer risks than the standard surgery. Doctors perform it by making small incisions in the groin to insert a thin tube and the collapsed device into an artery. Then, aided by X-rays, they guide the device to the aneurysm and expand it. Blood flows through the new channel, relieving pressure on the aorta

Each blocked the growth of blood vessels that tumors need for nourishment. The tumors stopped growing, and there was no spread of malignant cells. The scientists expect to begin testing the therapy on humans in 18 months

This paper reports the chemical synthesis of a new bile acid analogue, namely sodium 3 alpha,7 alpha-dihydroxy-25,26-bishomo-5 beta-cholane-26-sulfonate (bishomoCDC-sul) from chenodeoxycholic acid and describes its metabolism in the hamster. The structure of the new compound was confirmed by proton and carbon-13 nuclear magnetic resonance spectroscopy. After intravenous infusion of [3H]-labeled sulfonate into bile fistula hamsters, it was extracted by the liver and secreted into the bile; more than 65% of the radioactivity was recovered in the bile within 1 h. Following intraduodenal administration of the [3H]sulfonate and [14C]chenodeoxycholyltaurine, both compounds were excreted into the bile more slowly; only 41 and 43% of the radioactivity, respectively, were recovered in the bile during the four-hour experimental period. In contrast, when the labeled compounds were injected into the terminal ileum, both the sulfonate and chenodeoxycholyltaurine were rapidly absorbed and secreted into the bile; 84 and 97%, respectively, of the radioactivity were recovered during a four-hour period. Chromatographic analysis demonstrated that in these short-term experiments most (> 95%) of the sulfonate was secreted into the bile without biotransformation regardless of the route of administration. When infused intravenously at increasing doses, bishomoCDC-sul induced cholestasis at an infusion rate of 1 mumol/min/kg. These results suggest that sodium 3 alpha,7 alpha-dihydroxy-25,26-bishomo-5 beta-cholane-26-sulfonate was absorbed from the terminal ileum by active transport, extracted by the liver, and secreted into the bile in a manner similar to that of the natural bile acids.

The growth of managed care is changing the practice of medicine; it has a direct impact on the quality of care offered to women and may erode gains made in the field of women's health. Graduate medical education must be transformed if women's health is to be effectively represented in the evolving health care system. An interdisciplinary primary care specialty in women's health is the best strategy for preparing physicians to deliver cost-effective comprehensive care to women in a changing health care marketplace

Sleeping pills rarely cure insomnia. Various sleep disorders, factors that can cause them and when to seek help for a sleeping disorder are discussed

The purpose of this study was to examine the relationship of social support and religion to mortality after elective open heart surgery in older patients. Of the 232 patients included in the study, 21 died within 6 months of surgery. Three biomedical variables were significant predictors of mortality and selected as adjustment variables for a multivariate analysis: history of previous cardiac surgery; greater impairment in presurgery basic activities of daily living; and older age. Among the social support and religion variables, two were consistent predictors of mortality in the multivariate analyses: lack of participation in social or community groups and absence of strength and comfort from religion. These results suggest that in older persons lack of participation in groups and absence of strength and comfort in religion are independently related to risk for death during the 6-month period after cardiac surgery

In a community hospital in Brooklyn, New York, over a 3-year period, 79 methicillin-resistant Staphylococcus aureus (MRSA) isolates from five different case clusters were subtyped by Southern blot hybridization with two previously characterized gene probes, mec and Tn554. Together, the genotyping enabled the hospital infection control team to differentiate simultaneous MRSA clusters in the surgical intensive care unit (type I:A) and the open heart unit (type II:J), document the spread of one strain (type I:A) between roommates, identify an endemic strain (type II:J) from cardiac monitors and medical personnel, and identify an unrelated outbreak strain (type II:NH) in the labor and delivery unit. On the basis of this investigation it is clear that the routine DNA fingerprinting of MRSA in health care facilities, to monitor their spread and identify cases of nosocomial infections, is an important infection control measure

The publication of Derek Humphry's Final Exist in 1991 caused a large uproar. Although designed as a suicide manual for terminally ill persons, there has been considerable fear that the book's methods might be used by others, such as nonterminal elderly individuals who have made a "rational" decision to end their lives. This piece, a short story about an elderly couple that commits double suicide, explores rational suicide by using fiction, as opposed to a standard bioethical approach. Fiction does not provide answers, but rather highlights the ambiguities surrounding elder suicide, and reminds us to evaluate this issue in the context of individual life experiences.